OSA and Paroxysmal Atrial Fibrillation: Effect of Ablation and CPAP

In comorbid OSA and paroxysmal AF, how effective is catheter ablation with pulmonary vein isolation, and how does CPAP treatment affect AF recurrence?

In patients with obstructive sleep apnea (OSA) and paroxysmal atrial fibrillation (AF), continuous positive airway pressure (CPAP) treatment did not reduce the risk of recurring AF following catheter ablation with pulmonary vein isolation (PVI). Notably, with or without CPAP, PVI significantly reduced the burden of AF in patients with OSA. These were among clinical trial findings recently published in Heart Rhythm.

Prior studies have linked OSA with AF. Catheter ablation with PVI has become common to treat AF, reducing the need for additional treatment with drugs. Researchers sought to study patients with OSA who had undergone PVI for AF to determine how CPAP treatment affected AF recurrence in these patients.

The investigators in Norway conducted a randomized, controlled, open-label, parallel-group trial (ClinicalTrials.gov Identifier: NCT02727192) at Oslo University Hospital and at Rikshospitalet and St. Olav’s University Hospital in Trondheim, Norway, that included 83 patients with sudden AF (apnea-hypopnea index [AHI] ≥15 events/hour) who were randomized unevenly into CPAP treatment or standard care cohorts.

The investigators found that AHI in the CPAP group (n=37) decreased from 26.7±14 to 1.7±1.3 events per hour at follow-up (P =.001).  At least 1 episode of AF 3 to 12 months following PVI was experienced by more than half of patients in both the CPAP and standard care group (P =1.0 for difference between groups). There was also no between-group difference in reduction of AF burden following ablation (P =.69).

Researchers noted that, “In patients with paroxysmal AF and OSA, treatment with CPAP did not further reduce the risk of AF recurrence after ablation.” They concluded that the burden of AF in patients with OSA was noticeably reduced with PVI without any difference between patients treated with or without CPAP.

Researchers acknowledged that study limitations included unequal cohort sizes, an unblinded and open-label design, treatment bias, underpowered sample size, and limited generalizability in the study population, which included mostly White individuals from Northern Europe and was 80% male.


Hunt TE, Traaen GM, Aakerøy L, et al. Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after pulmonary vein isolation in patients with obstructive sleep apnea: A randomized controlled trial. Heart Rhythm. Published online June 16, 2022. doi:10.1016/j.hrthm.2022.06.016

This article originally appeared on Pulmonology Advisor